Switch medication from amitriptyline to paroxetine.
- Before day 1: gradually reduce dosage of amitriptyline to a maximum of 50-100 mg/ day, when this dosage is > 100 mg/day.
- Day 1-3: reduce dosage of amitriptyline to 50 mg/day.
- Day 4-7: reduce dosage of amitriptyline to 25 mg/day.
- Day 8: stop administration of amitriptyline.
- Day 9: start administration of paroxetine in a normal dosage of 20 mg/day.
- Day 16: increase dosage of paroxetine if necessary.
- Occurrence of the serotonin syndrome is not likely, but theoretically possible, so caution is necessary.
- Paroxetine is a strong inhibitor of CYP2D6, which metabolizes amitriptyline.
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